Was fetal distress diagnosed too late?

With complaints of mild vaginal bleeding, a 29-year-old woman at 40 weeks’ gestation presented to a medical center, where she underwent 2 nonreactive nonstress tests and an ultrasound examination. The ultrasound examination demonstrated reassuring fetal status and the woman was sent home.

She returned to the medical center in active labor 11 days later, but reported decreased fetal movement.

Fetal monitoring demonstrated late decelerations with absent long-term variability and no accelerations. A scalp-stimulation test, however, indicated adequate fetal response.

Ninety minutes later, profound terminal bradycardia was detected on fetal monitoring, prompting the staff to initiate an emergency cesarean delivery. The child required resuscitation on delivery and demonstrated signs of a seizure disorder. She now suffers from mental retardation and profound physical disability requiring constant care.

In suing, the woman noted that she did not receive instructions on monitoring fetal movement when discharged from her first emergency room visit. Further, she claimed, the diagnosis of fetal distress should have been made earlier, and cesarean delivery initiated sooner.

The parties settled for $2.6 million.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.